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APPLICATION FOR.-- <br />CITY OF�mO %.,ONSTRUCTION <br />everett PERMIT <br />DEPT. OF COMMUNITY DEVELOPMENT SERVICES <br />CITY HALL 259-8745 <br />EVERETT•WA98201 []COMBINATION <br />❑ BUILDING <br />❑PLUMBING PERMIT NO. <br />ereren <br />e <br />CITY ZIP PMONL IICENSE R <br />ZIP PHONE LICENSE <br />PIUMBING CONTRACTOR MAII ADDRESS <br />CITY IF <br />CLASS OF WORK <br />❑NEW ❑ADDITION ❑ALTERATION REPAIR ❑DEMOLITION ❑FENCE ❑SIGN ❑GARAGE 0 BUILDING RELOCATION <br />OF WORK <br />M I / <br />Y CERTIFY THAT I HAVE READ AND EXAMINED THIS AP - <br />P POSED OSf OF BUILDING <br />ON AND KNOW THE SAME TO RE TRUE AND CORRECT ALL <br />IONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE <br />IFGAI DES RI LION Of PRORRTY (5110WE�[lOW OR ATTACH FOUR CKF <br />K WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN <br />TO <br />�,Ij' <br />eLocK �-�oF <br />THE GRANTING OF A PERMIT DOES NOT PRESUME <br />OF <br />IUUCTION <br />LOT _,7, _ /. <br />1-:f=-ON <br />TO VIOLATE OR CANCEL THE <br />GIVE OSTIATE <br />OR LOCAL LAW REGULATING CONSTRTY <br />ER5 <br />PERFORMANCE OF CONSTRUCTION. <br />E OF CONTRACTOR OR AUTHORIZED AGENT DATE <br />10BADORES}��[ <br />MECHANICAL <br />PLUMBING <br />FEE <br />NO. TYPE OF EQUIPMENT FEE <br />NO. TYPE OF FIXTURE <br />AIR COND. UNITS—H.P. EA <br />WATER CLOSET FTOIIET) <br />REFRIGERATION UNITS—H P. EA <br />BATHTUB <br />BOII[0.5—N.P. EA <br />LAVATORY FWASH BASIN) <br />CAS FIRED A.C. UNITS —TONNAGE EA <br />SHOWER <br />FORCED AIR SYSTEM$—B.T.0 M EA <br />KITCHEN SINK b DISP <br />WAIL HEATERS—B.T.U. M <br />DISWASHER <br />UNIT HEATERS —BTU. M <br />LAUNDRY TRAY <br />EVAPORATIVE COOLERS <br />CLOTHES WASHE0. <br />CLOTHES DRYERS <br />WATER HEATER <br />VENTILATION FAN <br />URINAL <br />RANGE HOOD <br />DRINKING FOUNTAIN <br />AIR HANDLING UNIT— <br />- <br />FLOOR DRAIN <br />STOVE <br />VACUUM BREAKERS <br />METAL FIREPLACE b CHIMNEY <br />FEE <br />NO, <br />FEE <br />ROOF DRAINS —RAINLEADERS <br />' <br />SINK(SERVICE—BAR ETC) <br />B <br />SUB TOTAL <br />SUBTOTAL <br />PERMIT f <br />PERMIT <br />IS <br />TO7Al <br />PLAN CHECK NUMBER <br />FEES <br />FEf f <br />PLAN CHECK <br />FEE RECEIPT <br />VALUATION <br />TOTALFEE <br />f <br />SIDE YARD SETBACK <br />STRE[T SETBACK IF SETBACK <br />YARD SETBACK <br />USEZONE <br />LOT AREA <br />VACANT SITE <br />OYES ONO <br />TYPE OF CONST <br />OCCUPANCY GROUP NO. <br />OF DWELLING UNITS <br />BUILDING <br />S <br />S1ZE OF BLDG. <br />NO OF STORIES <br />MAX. OCC LOAD <br />PLUMBING <br />FIRE ZONE BASEMENT IIEDROOMS <br />FIRE SPRINKLERSREQUIED MECHANICAL <br />OYES ONO <br />APPROVALS <br />BY DATE OTHER <br />T ENVIRONMENTAL CHECK LIST <br />u'sC. <br />PENALTY SEC SEC. 103(a1 <br />TOTAL <br />2. BUILDING PLANS <br />FIRE HYDRANT <br />A. FIRE PROTECTION SYSTEM <br />P[RMIT VALIDATION <br />WHEN PROPERLY VALIDATED FIN THIS SPACE) THIS IT YOUR PERMIT <br />PROPERLYVA <br />S GRADINGIE.XCAVATION b CLEARINGIGRUBBING <br />6. DRAINAGE <br />7. ENVIRONMENTAL IMPACT STATEMENT <br />B. HEALTH DISTRICT <br />APPLICATION ACC. BY PLANS CHECKED BY <br />APPR. FOR ISSUANCE BY <br />9.179 <br />